scholarly journals Diagnosis of atypical mass-forming chronic pancreatitis mimicking pancreatic carcinoma: A case report

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Han-Yue Wang ◽  
◽  
Hao-Su Huang ◽  
Meng Wang ◽  
Jie Peng ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Chronic Pancreatitis ◽  
Pancreatic Carcinoma ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Multimodal Imaging ◽  
Needle Aspiration ◽  
Imaging Features ◽  
Pathological Findings ◽  
Fine Needle

Background: Mass-Forming Chronic Pancreatitis (MFCP) is rare. Moreover, atypical MFCP is difficult to differentiate from Pancreatic Carcinoma (PC) in clinical manifestations, laboratory, and imaging examinations. Diagnosis could be supported by the pathological findings of focal inflammatory fibrosis without evidence of tumor in the pancreas. Case summary: A 52-year-old man had acute pancreatitis twice over 7 months. Amylase and lipase levels were three times higher than the normal range without any clinical symptoms. At the 6th month, the patient lost 15 kg of weight, and abdominal ultrasonography revealed pancreatic head space occupied. All the findings in multimodal imaging including computed tomography image, Magnetic Resonance (MR) imaging with MR cholangiopancreatography, and 18F-FDG positron emission tomography/computed tomography showed an irregular nodule with low density, low signal, and low echo in the head of the pancreas, which were lower than those in the normal pancreatic tissue. The proximal main pancreatic duct was truncated and stenosed, and the distal duct was dilated. Subsequently, he developed progressive painless jaundice, and the specific tumor marker levels were increased. Most of these manifestations were suggestive of the pancreatic malignant tumor; however, multiple specimen pathological findings obtained from laparotomy and endoscopic ultrasonography-guided fine-needle aspiration revealed focal chronic inflammation, fibrosis, and necrosis. Conclusion: This report describes a case of atypical MFCP mimicking PC at clinical presentation and laboratory findings, especially in multimodal imaging. However, the combination of atypical multimodal imaging features, which support MFCP rather than PC, and endoscopic ultrasonography-guided fine-needle aspiration are useful for improving the diagnostic rate of atypical MFCP and avoiding unnecessary surgery.

Pre-operative Diagnosis of Pancreatic Neuroendocrine Tumors with Endoscopic Ultrasonography and Computed Tomography in a Large Series

2016 ◽  
Vol 25 (3) ◽  
pp. 317-321 ◽  
Author(s):  
Raffaele Manta ◽  
Elisabetta Nardi ◽  
Nico Pagano ◽  
Claudio Ricci ◽  
Mariano Sica ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Neuroendocrine Tumors ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Chromogranin A ◽  
Needle Aspiration ◽  
Large Series ◽  
Tumor Diameter ◽  
Pancreatic Neuroendocrine Tumors ◽  
Fine Needle

Background & Aims: Diagnosis of pancreatic neuroendocrine tumors (p-NETs) is frequently challenging. We describe a large series of patients with p-NETs in whom both pre-operative Computed Tomography (CT) and Endoscopic Ultrasonography (EUS) were performed. Methods: This was a retrospective analysis of prospectively collected sporadic p-NET cases. All patients underwent both standard multidetector CT study and EUS with fine-needle aspiration (FNA). The final histological diagnosis was achieved on a post-surgical specimen. Chromogranin A (CgA) levels were measured. Results: A total of 80 patients (mean age: 58 ± 14.2 years; males: 42) were enrolled. The diameter of functioning was significantly lower than that of non-functioning p-NETs (11.2 ± 8.5 mm vs 19.8 ± 12.2 mm; P = 0.0004). The CgA levels were more frequently elevated in non-functioning than functioning pNET patients (71.4% vs 46.9%; P = 0.049). Overall, the CT study detected the lesion in 51 (63.7%) cases, being negative in 26 (68.4%) patients with a tumor ≤10 mm, and in a further 3 (15%) cases with a tumor diameter ≤20 mm. CT overlooked the pancreatic lesion more frequently in patients with functioning than non-functioning p-NETs (46.5% vs 24.3%; P = 0.002). EUS allowed a more precise pre-operative tumor measurement, with an overall incorrect dimension in only 9 (11.2%) patients. Of note, the EUS-guided FNA suspected the neuroendocrine nature of tumor in all cases. Conclusions: Data of this large case series would suggest that the EUS should be included in the diagnostic work-up in all patients with a suspected p-NET, even when the CT study was negative for a primary lesion in the pancreas.– . Abbrevations: CgA: chromogranin A; EUS: Endoscopic Ultrasonography; FNA: fine-needle aspiration; p-NETs: pancreatic neuroendocrine tumors.

Endoscopic Ultrasonography

2018 ◽  
Author(s):  
Marvin Ryou ◽  
Nitkin Kumar
Keyword(s):  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Biliary Drainage ◽  
Bile Duct Stone ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Celiac Plexus ◽  
Fine Needle

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions.   Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst   This review contains 12 highly rendered figures, 2 tables, and 62 references.

Performance of the Standard 22G Needle for Endoscopic Ultrasound-guided Tissue Core Biopsy in Pancreatic Cancer

2016 ◽  
Vol 25 (2) ◽  
pp. 213-218 ◽  
Author(s):  
Andrada Seicean ◽  
Marcel Gheorghiu ◽  
Teodor Zaharia ◽  
Tudor Calinici ◽  
Andrada Samarghitan ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Chronic Pancreatitis ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Core Biopsy ◽  
Needle Aspiration ◽  
Biliary Stents ◽  
Fine Needle ◽  
The Core ◽  
Number Of Passes

Background & Aim: Endoscopic ultrasonography (EUS) and EUS-guided fine-needle aspiration (EUS-FNA) are considered good tools for the diagnosis of pancreatic cancer and for obtaining material for cytology or histology. The accuracy of EUS-FNA can rise to 85-95%, but it is lower in cases with a chronic pancreatitis background or with previous biliary stenting. We aimed to establish the diagnostic yield of the visible length of the core biopsy samples in pancreatic cancer by using one single type of standard 22G needle and to evaluate the factors which can influence the results. Method: EUS-FNA was performed by using a 22G standard needle on patients prospectively recruited with the suspicion of pancreatic masses on transabdominal ultrasound or CT scan over a period of eight months. The number of passes was limited by the length of the core obtained. The final diagnosis was based on EUS-FNA or hepatic biopsy for their metastasis or by follow up every three month by imaging methods. Results: The study included 118 patients. Previous stents were present in 10 patients and chronic pancreatitis features were found in 3 patients. The procedure sensitivity was 89% and the global accuracy was 89%. The presence of biliary stents did not impede the accuracy of results. The number of passes did not influence the results. Conclusions: The diagnostic rate of core biopsy by using 22G needles had a high accuracy and it is safe when the length of core dictates the number of passes. The presence of biliary stents did not influence the results. Abbreviations: AUC: area under the curve; EUS: endoscopic ultrasonography; EUS-FNA: fine needle aspiration under endosonographic guidance; FNA: fine needle aspiration; INR: international normalised ratio; OR: odds ratio.

Endoscopic Ultrasonography

2018 ◽  
Author(s):  
Marvin Ryou ◽  
Nitkin Kumar
Keyword(s):  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Biliary Drainage ◽  
Bile Duct Stone ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Celiac Plexus ◽  
Fine Needle

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions.  This review contains 12 highly rendered figures, 2 tables, and 62 references. Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst  

Endoscopic Ultrasonography

2016 ◽  
Author(s):  
Marvin Ryou ◽  
Nitkin Kumar
Keyword(s):  
Chronic Pancreatitis ◽  
Bile Duct ◽  
Endoscopic Ultrasonography ◽  
Fine Needle Aspiration ◽  
Biliary Drainage ◽  
Bile Duct Stone ◽  
Pancreatic Head ◽  
Needle Aspiration ◽  
Celiac Plexus ◽  
Fine Needle

Endoscopic ultrasonography (EUS) is a versatile tool that can be used to perform a variety of diagnostic and therapeutic procedures in the upper or lower gastrointestinal tract. The proximity of the echoendoscope to the pancreas, liver, and other thoracic and abdominal organs allows detailed examination or minimally invasive intervention that would not be feasible by surgical or percutaneous approaches. EUS is available with radial or linear scanning arrays and is capable of guiding fine-needle aspiration to acquire tissue for cytologic analysis. This review covers the role of EUS in chronic pancreatitis; pancreatic cysts; submucosal tumors; suspected choledocholithiasis; fecal incontinence; staging of malignancy in esophageal, pancreatic, gastric, and rectal cancer; celiac plexus block/neurolysis; fiducial placement; pseudocyst drainage and cystogastrostomy/cystoduodenostomy; endoscopic necrosectomy; and biliary drainage. Figures show peripancreatic cysts, gastrointestinal stromal tumor, common bile duct stone, esophageal adenocarcinoma, pancreatic head mass causing biliary obstruction and invading portal confluence, fine-needle aspiration of a pancreatic head mass, rectal adenocarcinoma, abdominal aorta with celiac artery and superior mesenteric artery, celiac plexus neurolysis, necrosectomy, and EUS-guided choledochoduodenostomy for failed endoscopic retrograde cholangiopancreatography. Tables list the Rosemont criteria for chronic pancreatitis and pancreatic cystic lesions.   Key words: bile duct stone, biliary drainage, echoendoscope, endoscopic ultrasonography, fine-needle aspiration, pancreatic cyst   This review contains 12 highly rendered figures, 2 tables, and 62 references.

scholarly journals Identifying Contraindication to Resection in Patients with Pancreatic Carcinoma: The Role of Endoscopic Ultrasound

2002 ◽  
Vol 16 (2) ◽  
pp. 109-114 ◽  
Author(s):  
Maurits J Wiersema
Keyword(s):  
Computed Tomography ◽  
Pancreatic Carcinoma ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Needle Aspiration ◽  
Imaging Modalities ◽  
Helical Computed Tomography ◽  
Dual Phase ◽  
Fine Needle

OBJECTIVE: To present recently published material comparing the performance of endosonography relative to other imaging modalities when evaluating the patient with a suspected or known pancreas carcinoma.METHODS: Medline was searched using the terms ‘endosonography’ and ‘pancreas neoplasms’. References from retrieved papers were reviewed to identify other reports. Emphasis was placed on peer-reviewed material published within the past three years that included comparison with other imaging modalities.RESULTS: Despite advances in cross-sectional imaging modalities, endosonography remains the most sensitive and specific method for identifying pancreatic mass lesions. The resectability of pancreatic carcinoma is best determined with dual-phase helical computed tomography, although endosonography may be slightly more accurate for lymph node assessment. Endoscopic ultrasound-guided fine needle aspiration biopsy has a high sensitivity (93%) and specificity (100%) when used in patients with masses in whom pancreatic cancer is suspected but prior biopsies have been negative.CONCLUSIONS: Endosonography helps in the diagnosis of pancreatic neoplasms through definitive inclusion or exclusion of a mass lesion as well as biopsy confirmation of malignancy. The role of endosonography in the determination of resectability has been eclipsed by dual-phase helical computed tomography. However, endoscopic ultrasound with fine needle aspiration of nonperitumoral lymph nodes may identify advanced disease with sufficient frequency to justify its routine use in patients with lesions that are thought to be resectable based on helical computed tomography.

Sign in / Sign up

Export Citation Format

Share Document